High Prevalence of Hypertension Among Collegiate Football Athletes
Karpinos AR, Roumie CL, Nian H, Diamond AB, Rothman RL. Circ Cardiovasc Qual Outcomes. 2013;6:00-00.
Take Home Message: College football athletes may have a higher prevalence of hypertension than college male nonfootball athletes.
Routine physical activity is an established means of reducing blood pressure; however, a recent study of National Football League players found that they had a higher prevalence of hypertension compared with the general population – 14% versus 6%. It is challenging to know if these findings are applicable to college football athletes because there is limited research in this area. Therefore, Karpinos and colleagues conducted a retrospective cohort study to determine the prevalence of hypertension among collegiate football athletes compared with nonfootball male athletes. The authors reviewed the medical charts (1999-2012) of 636 male athletes from a Southeastern Conference Division I university, which included 323 football athletes and 313 nonfootball athletes. Data collected included blood pressure, body mass index, medication use, and supplement use in the initial through final years of participation. The authors excluded athletes if they had a history of cardiac or renal abnormality or surgery, no preparticipation physical evaluation records, or no initial blood pressure collected. Blood pressure classifications from Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7 were used: 1) Normal blood pressure = systolic below 120 mmHg and diastolic below 80 mmHg, 2) Prehypertension = systolic of 120-139 mmHg or diastolic of 80-89 mmHg, and 3) hypertension = systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg, history of hypertension, or use of an antihypertensive medication. The authors found that football players were more likely to be black, have a higher initial body mass index, and parental history of hypertension. Overall, 19% of football athletes had hypertension in both their initial and final years of participation, which was higher than the nonfootball athletes - 7% and 10%. The authors also found that 76% of all male athletes had prehypertension or hypertension.
The authors found similar results compared to previous smaller studies of hypertension among college football athletes – 23.5% and 14%. The authors noted that a limitation to their study is that they focused on one school, but if this data is accurate, male college athletes may have an increased cardiovascular risk that should be followed more closely. This elevated blood pressure could be due to multiple factors, such as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), high salt intake, strength and resistance training, the pressure of competition, stimulant use, supplement use, increased body mass index, or race. The authors also question whether the current guidelines of hypertension for the general population can be applied to the athletes. Can the high blood pressure be explained by the football players having a higher body mass index than nonfootball players, or is their body mass index overestimated due to increased muscle mass? Once a high blood pressure reading is identified, a follow-up plan should be made to repeat the blood pressure in several weeks. Ideally, this should be done when all factors for an elevated reading are eliminated, such as the athlete having just finished a workout or a caffeinated beverage, or using NSAIDs. By educating athletes at a young age regarding their cardiovascular health, hopefully this can carry over to their adult years. Further research may help us define the significance of hypertension in a athletic population and how to optimally manage it in the university setting.
Questions for Discussion: What programs do you have at your university to monitor blood pressure in your athletes? What patient education or advice do you provide to these athletes?
Written by: Kris Fayock, MD
Reviewed by: Jeffrey Driban